Even on a per-capita basis, India does poorly. The study estimates that for every 1,000 children born in India, 61 are unlikely to make it to their fifth birthday. That rate is higher than, say, in Rwanda (54 child deaths), Nepal (48 child deaths) or Cambodia (43 child deaths).

The Unicef study, released today, shows child mortality rates in India are not as bad as in sub-Saharan Africa, where it estimates 109 in every 1,000 children are likely to die before five. Children have the least chance of survival in Sierra Leone, where the rate is 185 child deaths every 1,000 births.

The report showed the main causes of child deaths worldwide are pneumonia, responsible for 18% of deaths, followed by diarrhea (11% of deaths).

India stands out for the prevalence of diarrhea as a killer of infants. Diarrhea was responsible for 13% of child deaths in India in 2010 – the second-highest rate after Afghanistan.

Associated with poor sanitation, malnutrition and lack of access to basic healthcare services, this is an easily preventable disease that strikes mainly the poor.

Washing hands with soap, clean drinking water and putting an end to open defecation – which the report found is a major cause of diarrhea in South Asia – are easy preventative measures.

The report singled out India as an example of a country where “rapid economic growth and strong inflows of trade and investment in recent years have failed to bring about corresponding reduction of inequities in under-five mortality.”

Officials at India’s ministry of health were not available for comment.

India, which spends 1.4% of its GDP on healthcare, has promised to ramp up that ratio to 2.5% by 2017 – a target it has repeatedly missed in the past. The country recently boosted its public spending on malnutrition programs, which target mainly children.

Globally, the number of children who die under the age of five fell by almost half between 1990 and 2011. But the report suggests the world will struggle to meet the U.N. Millennium Development goal of bringing down the child mortality rate to 29 deaths per 1,000 births by 2015 given the rate stood at 51 deaths in 2011.

India’s target under its Millenium Development goal commitments is to get its death rate down to 38 per 1,000 deaths by 2015. Although the death rate of children under the age of five in India has dropped 46% since 1990, it will need to speed up its efforts to meet that target.